North Dakota - Skilled Respite Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

North Dakota Department of Health and Human Services (HHS) does not issue a standalone license for Skilled Respite Services; instead, providers must first hold an active license as a Home Health Agency, Nursing Facility, or Hospital through the HHS Public Health Regulation, Licensure and Certification division. Because the state relies on these existing medical licenses to ensure clinical competency, applicants cannot enroll in Medicaid to provide nursing-level respite without first securing one of these primary facility or agency credentials.

Approval to bill North Dakota Medicaid for skilled respite requires enrolling through the Medicaid Management Information System (MMIS) Web Portal using a National Provider Identifier (NPI) tied to the underlying medical license. Applicants must submit the Medicaid Provider Agreement (SFN 615) and demonstrate that their licensed capacity and staffing patterns meet the standards of their primary Medicare or state-approval authority.

1. Service Definition and Scope

In North Dakota, skilled respite care provides temporary relief to primary caregivers of individuals whose medical needs exceed what an unlicensed caregiver can safely manage. The service is funded through various authorities, including the Autism Spectrum Disorder Birth through Eleven Waiver and traditional ID/DD waivers.

Because the service requires nursing-level intervention, it must be delivered by licensed medical personnel in the home or within a licensed healthcare facility. The state defers to the provider's primary licensing authority for specific clinical scope and staffing ratios.

• Service Name: Respite Care (Skilled/Nursing level)
• Target Population: Individuals on North Dakota Medicaid waivers requiring ICF/IID or nursing facility level of care.
• Delivery Setting: In-home (via Home Health Agencies) or facility-based (Nursing Facilities, Hospitals).
• Capacity Limit: Facility-based respite cannot exceed the provider's licensed or approved bed capacity; respite patients must be counted in the daily census.
• Scope of Practice: Must be delivered by a Registered Nurse (RN) or Licensed Practical Nurse (LPN) under RN supervision, per the North Dakota Nurse Practice Act (N.D.C.C. § 43-12.1).

2. Regulatory and Oversight Agencies

The North Dakota Department of Health and Human Services (HHS) oversees all aspects of Medicaid and facility licensure. Different divisions within HHS handle the physical licensure, the waiver administration, and the Medicaid enrollment process.

Provider enrollment processing is contracted out to Noridian Healthcare Solutions, which manages the intake of applications and documentation for the state.

• Licensing Authority: ND HHS Public Health Regulation, Licensure and Certification (https://www.hhs.nd.gov/health/regulation-licensure-and-certification)
• Medicaid Agency: North Dakota Medicaid (https://www.hhs.nd.gov/healthcare/medicaid)
• Enrollment Contractor: Noridian Healthcare Solutions (https://www.hhs.nd.gov/healthcare/medicaid/provider-enrollment)
• Waiver Oversight: ND HHS Autism Services Division and Developmental Disabilities Division (https://www.hhs.nd.gov/healthcare/medicaid/medicaid-waivers)

3. Gatekeeping Prerequisites: Who Can Even Apply

North Dakota does not offer a distinct "Skilled Respite" license or enrollment category for standalone businesses. To provide this service, an entity must already be established and licensed as a higher-level medical provider.

These structural prerequisites must be fully satisfied before an applicant can even submit a Medicaid enrollment application to Noridian.

• Prerequisite License: An applicant must hold an active North Dakota Home Health Agency, Nursing Facility, or Hospital license before applying for Medicaid enrollment.
• Medicare Certification: Home Health Agencies must be certified to participate in the Medicare program prior to North Dakota Medicaid enrollment.
• Capacity Restriction: Facility-based providers must have available licensed bed capacity; a facility operating at maximum census cannot accept respite placements.
• NPI Requirement: The applicant must possess a National Provider Identifier (NPI) enumerated for the specific facility or agency type before submitting the Medicaid application.

4. Licensure and Certification Requirements

Because skilled respite is an add-on service provided by existing healthcare facilities and agencies, the licensure requirements are dictated by the provider's primary operational category.

The North Dakota Administrative Code outlines the specific physical and operational standards for these underlying licenses.

• Home Health Licensure: Governed by N.D. Admin. Code for Home Health Agencies, requiring adherence to state public health regulations.
• Staffing Patterns: Providers must meet the staffing patterns defined by their primary licensing or Medicare-approval authority; no separate respite staffing standard applies.
• Sleeping Accommodations: Facility-based providers must provide the same sleeping accommodations available to standard residents or patients of the facility.
• Out-of-State Providers: Must be located within 50 miles of the North Dakota border to enroll as a standard provider, or obtain specific service authorization for out-of-network care.

5. Medicaid Provider Enrollment

Enrollment is managed through the North Dakota Medicaid Management Information System (MMIS) Web Portal. Applications are processed by Noridian Healthcare Solutions.

Providers must submit both the online application and the required physical or digital forms before processing begins.

• Application Portal: ND Medicaid Management Information System (MMIS) Web Portal.
• Required Form: ND Medicaid Provider Agreement (SFN 615).
• Out-of-State Form: Out of State/Out of Network Enrollment Clarification Form (SFN 509) if applicable.
• Submission Methods: Online portal, email ([email protected]), fax (701-433-5956), or mail to Noridian Healthcare Solutions in Fargo.
• Effective Date: Can be requested up to 90 days prior to the receipt of the complete application packet, but cannot predate the NPI enumeration date.

6. Staffing, Training and Background Checks

Staff delivering skilled respite must hold the appropriate clinical credentials required by the North Dakota Board of Nursing. Unlicensed personnel cannot deliver the skilled nursing components of this service.

All staff must pass federal exclusion checks to ensure they are eligible to participate in Medicaid-funded programs.

• Nursing Standards: Services must be provided by a Registered Nurse (RN) or Licensed Practical Nurse (LPN) operating within their legal scope of practice.
• Exclusion Checks: Staff must be free of exclusions from federally funded programs, including the LEIE and SAM databases.
• Supervision: Direct supervision means the supervising provider can visualize and be immediately available to the supervisee at all times while services are provided.
• Trainees: Unlicensed health care trainees registered with their board cannot enroll or bill North Dakota Medicaid directly.

7. Documentation, Policies and Records

Providers must maintain rigorous medical records that comply with both their primary licensing standards and North Dakota Medicaid policies.

Documentation must clearly demonstrate the medical necessity of the skilled interventions provided during the respite period.

• Record Maintenance: Facilities must maintain individual charts or records identical to those required for standard residents or patients of the facility.
• Orders: Services must be based on a licensed physician’s orders and a written plan of care.
• Amendments: Corrections to medical documentation must follow ND Medicaid policy, which strictly prohibits back-dating, post-dating, or writing over existing entries.
• Confidentiality: All records must comply with HIPAA and be accessible to ND Medicaid personnel without member authorization for payment and healthcare operations.

8. Billing, Rates and Claims

Claims for skilled respite are submitted through the MMIS portal. Providers must ensure they are billing under the correct NPI and adhering to the state's correct coding guidelines.

Medicaid payment must be accepted as payment in full, with providers only permitted to collect authorized recipient liability amounts from members.

• Payment Standard: Providers must accept Medicaid payment as payment in full, collecting only recipient liability from the member.
• Usual and Customary: Billed charges must reflect the provider's usual and customary charge to the general public.
• Procedure Codes: Providers must use the ND Medicaid Procedure Code Look-up Tool to verify current covered codes, rates, and Service Authorization requirements.
• Billing NPI: Services by limited-license providers must be billed under the supervising provider's NPI if they are not required to enroll independently.

9. Approval Sequence and Timeline

Becoming a skilled respite provider is a sequential process that begins with obtaining the necessary facility or agency license. Medicaid enrollment cannot proceed until this foundational step is complete.

Once the application is submitted to Noridian, providers will receive their credentials via mail or through the online portal.

• Step 1: Obtain Medicare certification (for Home Health Agencies) or state facility licensure from ND HHS Public Health Regulation.
• Step 2: Obtain an NPI matching the specific provider type and location.
• Step 3: Submit the online enrollment application and the SFN 615 Provider Agreement to Noridian.
• Step 4: Receive a 7-digit Medicaid ID number via USPS or register directly on the MMIS Web Portal if security info was provided during application.
• Timeline: Retroactive enrollment may be approved up to 90 days prior to application receipt, provided all eligibility requirements were met on the date of service.

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied due to administrative errors or failure to maintain the underlying facility license requirements.

Surveyors pay close attention to capacity limits and staffing ratios during facility inspections.

• Capacity Violations: Exceeding licensed bed capacity by failing to count respite individuals in the facility's daily census.
• Incomplete Applications: Application processing does not begin until both the online submission and all required documentation (e.g., SFN 615) are received by Noridian.
• Invalid Effective Dates: Requesting an enrollment effective date prior to the NPI enumeration date, resulting in application rejection.
• Unapproved Out-of-State Care: Out-of-state providers failing to secure service authorization for non-emergency respite services.

11. Key Contacts and Resources

Providers should rely on the official North Dakota HHS portals and the Noridian enrollment contractor for the most current forms and policy manuals.

The MMIS portal is the primary hub for both enrollment tracking and claims submission.

• ND HHS Public Health Regulation, Licensure and Certification: https://www.hhs.nd.gov/health/regulation-licensure-and-certification
• ND Medicaid Provider Enrollment Information: https://www.hhs.nd.gov/healthcare/medicaid/provider-enrollment
• Noridian Provider Enrollment Email: [email protected]
• ND Medicaid Waivers Information: https://www.hhs.nd.gov/healthcare/medicaid/medicaid-waivers

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